Department of Surgery, DUMC 3351, Duke University Medical Center, Durham, NC 27713, USA.
Surg Endosc. 2012 Apr;26(4):1086-94. doi: 10.1007/s00464-011-2004-7. Epub 2011 Nov 2.
The effects of gastric bypass surgery on the secretion of the anorexigenic gut-derived hormones glucagon-like peptide-1 (GLP-1) and peptide YY (PYY), independent of caloric restriction and due to different dietary macronutrients, is not well characterized. This study examines the effects of a mixed-nutrient or high-fat liquid meal on the postprandial stimulation of GLP-1 and PYY following gastric bypass or equivalent hypocaloric diet.
Total PYY and active GLP-1 were measured fasting and at multiple points after standardized mixed-nutrient and high-fat liquid meals in two matched groups of obese subjects. The meal stimulation tests were performed before and 14.6 ± 3.3 days after gastric bypass (GBP, n = 10) and before and after a 7-day hypocaloric liquid diet matching the post-GBP diet (control, n = 10).
Mixed-nutrient and high-fat postprandial GLP-1 levels increased following GBP (mixed-nutrient peak: 85.0 ± 28.6-323 ± 51 pg/ml, P < 0.01; high-fat peak: 81.8 ± 9.6-278 ± 49 pg/ml, P < 0.01), but not after diet (mixed-nutrient peak: 104.4 ± 9.4-114.9 ± 15.8 pg/ml, P = NS; high-fat peak: 118.1 ± 16.4-104.4 ± 10.8 pg/ml, P = NS). The postprandial PYY response also increased after GBP but not diet, though the increase in peak PYY did not reach statistical significance (GBP mixed-nutrient peak: 134.8 ± 26.0-220.7 ± 52.9 pg/ml, P = 0.09; GBP high-fat peak: 142.1 ± 34.6-197.9 ± 12.7 pg/ml, P = 0.07; diet mixed-nutrient peak: 99.8 ± 8.0-101.1 ± 13.3 pg/ml, P = NS; diet high-fat peak: 105.0 ± 8.8-103.1 ± 11.8 pg/ml, P = NS). The postprandial GLP-1 response was not affected by the macronutrient content of the meal. However, following GBP the mixed-nutrient PYY total area under the curve (AUC(0-120)) was significantly greater than the high-fat PYY AUC(0-120) (22,081 ± 5,662 pg/ml min vs. 18,711 ± 1,811 pg/ml min, P = 0.04).
Following GBP there is an increase in the postprandial stimulation of PYY and GLP-1 that is independent of caloric restriction. The phenomenon of "bariatric surgery-induced anorexia" may be linked to the increased levels after GBP.
胃旁路手术后，由于不同的饮食宏量营养素，而不仅仅是热量限制，会对肠源饱腹感荷尔蒙胰高血糖素样肽-1（GLP-1）和肽 YY（PYY）的分泌产生影响，但目前对此了解甚少。本研究旨在探讨混合营养素或高脂肪液体餐对胃旁路术或等效低热量饮食后 PYY 和 GLP-1 餐后刺激的影响。
两组肥胖患者分别接受标准化混合营养素和高脂肪液体餐，在餐前和餐后多个时间点测量总 PYY 和活性 GLP-1。在胃旁路术（GBP）前和术后 14.6 ± 3.3 天（GBP 组，n = 10）以及低热量液体饮食前和术后 7 天（对照组，n = 10）进行餐刺激试验。
GBP 后混合营养素和高脂肪餐后 GLP-1 水平升高（混合营养素峰值：85.0 ± 28.6-323 ± 51 pg/ml，P < 0.01；高脂肪峰值：81.8 ± 9.6-278 ± 49 pg/ml，P < 0.01），但饮食后无变化（混合营养素峰值：104.4 ± 9.4-114.9 ± 15.8 pg/ml，P = NS；高脂肪峰值：118.1 ± 16.4-104.4 ± 10.8 pg/ml，P = NS）。GBP 后 PYY 的餐后反应也增加，但饮食后无变化，尽管 PYY 峰值的增加未达到统计学意义（GBP 混合营养素峰值：134.8 ± 26.0-220.7 ± 52.9 pg/ml，P = 0.09；GBP 高脂肪峰值：142.1 ± 34.6-197.9 ± 12.7 pg/ml，P = 0.07；饮食混合营养素峰值：99.8 ± 8.0-101.1 ± 13.3 pg/ml，P = NS；饮食高脂肪峰值：105.0 ± 8.8-103.1 ± 11.8 pg/ml，P = NS）。餐后 GLP-1 反应不受膳食宏量营养素含量的影响。然而，GBP 后混合营养素 PYY 的总曲线下面积（AUC(0-120)）明显大于高脂肪 PYY AUC(0-120)（22081 ± 5662 pg/ml min vs. 18711 ± 1811 pg/ml min，P = 0.04）。
GBP 后 PYY 和 GLP-1 的餐后刺激增加，与热量限制无关。“减重手术后厌食”的现象可能与 GBP 后水平升高有关。
